How to spot (and stop) weight bias and stigma
Weight bias and stigma, which results in people being treated differently because of their body size, can get under your skin—literally. A 2018 report found that experiencing weight bias and stigma can be as harmful to a person as the effects of obesity itself. And it happens to a broader swath of people than you might imagine: More than 40% of U.S. adults across a range of sizes report experiencing weight stigma at some point in their life, according to a 2021 study in the International Journal of Obesity. Here’s how to spot it (the signs can be subtle) and ways to combat it at every level.
What is weight bias and stigma?
The two concepts are closely linked, but aren’t quite the same thing. Weight bias refers to “negative thoughts or attitudes about obesity or people with higher weight/larger bodies,” says Kate W. Bauer, Ph.D., associate professor of nutritional sciences at University of Michigan’s School of Public Health. “Weight stigma is then the discriminatory behaviors or practices against people with higher weight/larger bodies that occur because of those negative thoughts or attitudes.” Like other forms of discrimination, weight stigma can happen on both a personal level, like being bullied or excluded, as well as in a larger systemic or institutionalized way.
Where does weight bias and stigma occur?
If you want a shorter answer, you might want to ask where weight bias and stigma doesn’t occur. That’s because weight stigma can emerge in almost any setting—including schools, workplaces, doctors offices, and even on public transportation. “Weight stigma shows up in so many ways that many people are probably not even aware of how often they encounter it as they move through their day,” says Bauer. And it can be both obvious or more subtle.
Weight bias from healthcare providers
It’s a place you’re supposed to feel safe and supported on your health journey, but it often doesn’t feel that way. “Patients with higher body weight report being stigmatized from healthcare providers, who express negative stereotypes and biases toward them,” says Rebecca Puhl, Ph.D., a clinical psychologist and the deputy director for The Rudd Center for Food Policy & Health at the University of Connecticut. “This can lead to poorer quality of care and communication between providers and patients and can even lead patients to avoid healthcare.” This might lead to a doctor not fully investigating a medical complaint—instead just insisting that the patient lose weight or “prescribing” them a diet to fix what ails them— or a misdiagnosis instead of a referral or further testing. It doesn’t help that doctors more often describe heavier patients with negative terms such as “weak-willed,” “lazy,” and “noncompliant.” Even things like the size of blood pressure cuffs, chairs in the waiting room, and hospital gowns can be stigmatizing for people with larger bodies.
Weight bias at work
In the workplace, “people face prejudice and unfair treatment because of their weight, which can happen at the level of hiring, but also in regard to promotion potential and job termination,” says Puhl. Those living with obesity also tend to have lower incomes, something researchers say is partly due to stigma. But many times, weight bias at work can be hard to spot, or couched behind giggles. “Perhaps you work in an office that only has narrow chairs that not everyone can comfortably fit into, or where someone says derogatory ‘jokes’ about people with higher weight,” says Bauer.
Weight bias in relationships
Even relationships with family and friends are not immune. “Family members are one of the most common sources of weight teasing and judgmental comments about weight,” says Puhl. Have you ever had a relative make a pointed remark when you’re serving yourself or say yes to dessert? Weight bias. This can be especially hard on teens, with one study showing that adolescents felt more insecure, embarrassed, and hurt when parents brought up their weight in critical ways.
Weight bias throughout the day
In buildings and on public transportation, the most basic of things—the size of chairs or airplane seats, for example—are not always sized adequately to easily accommodate people in bigger bodies. Even just the subtle side-eye or audible sighs from passengers when someone larger sized is seated next to them can be harmful—and obvious.
What part does the media play in weight bias?
It can be hard to say exactly where someone’s weight bias comes from, but popular media definitely reinforces the idea that people in larger bodies are somehow less worthy. “We see negative weight-based stereotypes and stigmatizing portrayals of people with higher weight in television, film, news, social media, and advertising,” says Puhl. “As an example, my research team found that about two-thirds of news reports about obesity contain images that portray people in ways that reinforce negative weight stereotypes.” Think of pictures showing heavier people as lazy, sloppy, or undisciplined.
Body shaming and weight bias remains a constant in television and film, whether it’s reality TV shows, sitcoms, or cartoons. Ever notice “how in TV shows the stars and popular people are often thin, while the funny sidekicks or less desirable people are heavier,” says Bauer. And it starts young: Researchers have studied top-grossing children’s movies and found that over 80% contain content that promotes weight stigma, and that more than half of youth-targeted TV shows contain negative comments about the appearance of a character with a larger body, says Puhl. When you’re continually exposed to these sorts of characterizations from a young age, it can’t help but burrow deep into your value system and psyche. Without even realizing it, you see larger bodies negatively and internalize that being heavy is bad (both when thinking about other people’s bodies and your own).
What are the effects of weight bias on well-being?
There are still people who believe that “encouraging” someone to lose weight through stigmatizing comments can be a powerful motivator and ultimately help someone improve their health, but the truth is quite the opposite. “There seems to be a belief that heavier people don't know they're heavier, and if someone just told them then they'd ‘wake up’ and change, but that is absolutely not true,” says Bauer. Being shamed or stigmatized about weight can be harmful in multiple aspects of a person’s life. These include:
- Emotional well-being: Weight stigma can contribute to increased depression, anxiety, lower self-esteem, and poorer body image—even raise the risk of suicidality. “It is exhausting and upsetting to walk through life constantly being reminded that your body, and you, do not belong and are less worthy of happiness and health than someone who is thinner,” says Bauer. “Heavier people are always on guard, worried they will be insulted or dismissed or just ‘take up too much space.’”
- Physical health: This constant stress of feeling stigmatized against can raise your risk of health problems such as high blood pressure, type 2 diabetes, and cardiovascular disease. The chronically higher levels of cortisol can make it harder for your body to regulate inflammation and can increase visceral fat levels, two things that are linked to many chronic health conditions. Weight stigma can even lead to weight gain and ultimately increase the risk of mortality. It doesn’t help that, as Puhl notes, weight stigma leads people to avoid physical activity due to a fear of being judged.
- Level of healthcare: “People with higher weights go to the doctor and are told losing weight will solve all their health problems; they are denied evidence-based treatments because doctors don't think that they have the willpower to be compliant,” says Bauer. There may be medical equipment that’s not sized correctly for bigger bodies and doctors may also spend less time with people with higher weights. As a result, those who have larger bodies and experience stigma are less likely to go to see a healthcare provider in the future.
How can you identify if weight stigma is happening to you?
For the more obvious types of weight stigma, many people with higher weight are already aware that they’re being treated in a way that doesn’t make them feel good. “People know that mainstream stores don't often carry their size, or that they get stared at when they're eating or exercising,” says Bauer.
But the more subtle forms of weight stigma might be harder to pinpoint. According to Puhl, if you feel you are being treated unfairly by others because of your body weight or size, and the mistreatment can’t be explained by something else, such as being passed over for a job you were clearly the most qualified for or being told that a medical issue is simply a weight problem, that is weight stigma.
“If you are being verbally teased about your weight or size, that is weight stigma. If someone is blaming or shaming you for your weight, or applying stereotypes to you because of your body size, that is weight stigma,” says Puhl. “It can look different across different situations, but at the core of these experiences are themes of being devalued, rejected, judged, blamed, or dismissed because of one’s body.”
How can you advocate for yourself?
Removing yourself from situations and relationships where you feel stigmatized against is an important step in avoiding many of the negative impacts of weight bias and stigma. Here’s what else you can do:
- Take stock of your mindset. “It’s vital that you know that you deserve good things and proper treatment, regardless of your weight,” says Bauer. “For some people it might require a really strong social support system or working on the issue with a mental health professional to get there. But once you believe that, it becomes easier to stand up for yourself in difficult situations.”
- Keep a written record. If you feel that weight bias is impacting your career or education, Puhl suggests that you “write down the details of the discrimination that occurred, and share it with a manager or someone with authority who can help take steps to address the situation.” For example, record the date and time, what you observed or heard, and who was present during the situation. “You can also save discriminatory messages that you receive in texts, emails, or on social media, so that you have this evidence,” says Puhl.
- Talk to advocates. In workplaces, schools, and medical offices, there are people whose job it is to help you fight stigma. Talk to your HR department about adding obesity to your company’s anti-harassment policy or meet with a patient advocate within your healthcare group to talk about ways that providers have talked to you about your weight.
- Find a better doctor. This is a big one: You want to see medical providers you feel comfortable with, especially ones that don't always turn to weight as the source of problems, says Bauer. Look for doctors that are specifically well-versed in obesity. (The Obesity Action Coalition (OAC) has a great list of Obesity Care Providers.) If you feel that weight bias is happening in healthcare visits, arm yourself with information and a readiness to self-advocate, says Puhl. And if things don’t change, consider going to a new healthcare provider who can make you feel comfortable and validated.
- Push back. Hear a fat joke? The OAC suggests shutting it down by saying something simple like “These jokes are harmful and reinforce society’s stigma.” If you spot weight bias in the media, consider contacting the OAC to flag them so that their Weight Bias Task Force can tackle them head on.
- Get political. Send a letter or email to your local or state legislator to encourage them to support policy-level solutions to reduce weight bias. Only one state (Michigan) currently has legislation that explicitly bans discrimination based on body size. Weight status is not included as a protected class under the US Equal Employment Opportunity Commission, the Fair Housing Act, or the Food and Nutrition Act (which prohibits discrimination in SNAP), notes Kathryn M. Ross, PhD, MPH, associate professor in the department of clinical & health psychology at the University of Florida.
The bottom line
Weight bias and stigma can negatively impact people in so many ways, from raising their risk for serious health conditions and reducing the quality of their healthcare to making it harder to have a successful career or simply travel on an airplane. Being a strong self-advocate and well-informed about where weight bias can occur can help you feel prepared to fight back and reduce the risk that comes from being stigmatized against.